Booking Form - DanceXchange

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Class Programme Taster Workshop
Booking Form
Personal Details
First Name
Surname
DOB (DD/MM/YY)
Address
Telephone No.
Email Address
Do you have any medical conditions, specific needs or access requirements that we should be
aware of? Please give details.
Emergency Contact Details
Name
Telephone No.
Home
Mobile
Relationship to applicant
Taster Class(es) attending
Please return to heather.maclaurin@dancexhange.org.uk or DanceXchange Ltd. // Birmingham Hippodrome //
Thorp Street // Birmingham // B5 4TB. T. 0121 689 3170
F. 0121 689 3170 // Company Limited by Guarantee // Company No. 2784677 // VAT No. 614 222 875. Registered
Charity No. 1045364 // Registered in England & Wales
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